Healthcare Provider Details

I. General information

NPI: 1720432818
Provider Name (Legal Business Name): WILLIAM LEE THOMPSON III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SAINT FRANCIS AVE
SHAKOPEE MN
55379-3387
US

IV. Provider business mailing address

8170 33RD AVE S
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 952-993-7672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number76666
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: